Symptoms of acute otitis media

There are significant differences in the symptoms of acute otitis media in children and adults.

Acute otitis media is mild: the general condition does not change, there is no temperature reaction, the anamnesis most often includes acute respiratory viral infections. During otoscopy, the eardrum is almost unchanged, the level of exudate is occasionally determined. Patients complain of hearing loss, a feeling of congestion in the ear. In young and preschool children, complaints may be absent due to fear of examination by a doctor, therefore the role of the pediatrician in suspected hearing loss should be more active, and the child should be referred to an otolaryngologist for a hearing test.

Recurrent otitis media occurs in children aged 2 to 5 years. The clinical course is usually comparatively mild. The disease occurs in two forms: with and without perforation. The first symptom is mild pain in the ear and a feeling of congestion. However, in this period, unfortunately, the disease is often not diagnosed, since children do not always complain of hearing loss, especially with a unilateral process, there is no temperature reaction, and there is usually no intoxication. To establish a diagnosis in this period, it is important to study the hearing function using acoustic impedancemetry.

Adhesive otitis media is a consequence of an unfavorable course of acute otitis media. As already noted, the criteria for recovery are the resorption of exudate in the tympanic cavity and complete restoration of hearing function. However, sometimes even with active antibiotic treatment, this exudate becomes sterile, the temperature and pain disappear, and visible recovery occurs. Most often, this happens with poor drainage of the auditory tube, the absence of perforation of the eardrum, or paracentesis not performed in a timely manner. Indeed, the general condition of the child becomes normal, as does the otoscopic picture. Only hearing loss remains, and sometimes - noise in the ear. This situation requires active audiological diagnostics, since children, as a rule, do not complain of hearing loss. Each case of acute otitis media in a child requires confirmation of normal hearing function.

If the exudate begins to organize and the fibrous threads turn into adhesions, then the conduction of sound is disrupted, and persistent conductive hearing loss occurs. An audiological study indicates damage to the sound conduction function.

Symptoms of acute otitis media are varied and largely depend on age; it is most difficult to diagnose newborns and infants. Anamnesis plays an important role in diagnosis. It is necessary to find out what caused the deterioration in the child's condition. Most often, ear disease is preceded by acute rhinitis, acute respiratory viral infection, sometimes trauma (falling from a crib), allergic diseases.

The leading symptom of acute otitis media is severe, often sudden spontaneous pain. It is associated with the rapid accumulation of exudate in the tympanic cavity and pressure on the endings of the trigeminal nerve, which innervates the mucous membrane. The child's reaction to pain is expressed differently, depending on age. Thus, up to 5-6 months, the child is still unable to determine the localization of pain. That is why he reacts to pain only by screaming, pendulum-like shaking of the head. Rocking in the arms does not help, refuses breastfeeding, since movements in the joint of the lower jaw are easily transmitted during sucking to the external auditory canal and tympanic cavity; sometimes prefers to choose the breast opposite the sore ear. When the ear is below, the pain subsides slightly. The preferred position of the head in the crib on the sore side is also associated with this, apparently, the warmth from the pillow also somewhat reduces pain. The method of examining the child's reaction to pressure on the tragus (Vash's symptom), which is quite common among pediatricians, should be treated critically, since a large number of false-positive reactions are observed. This study is recommended to be carried out during sleep. The same applies to the child's reaction to pressure on the area behind the ear, since it is known that at this age the cellular system of the mammillary process has not yet formed.

An important general symptom is high temperature. On the second or third day of the disease, it usually rises sharply - up to 39-40 "C. However, there is a variant of the course of the disease (the so-called latent otitis), when the temperature is set at subfebrile numbers. The rise in temperature is accompanied by severe intoxication, often expressed in excitement: the child does not sleep, screams, the condition worsens at night, sometimes, on the contrary, becomes depressed, apathy, refusal to eat, vomiting, regurgitation, increased stool frequency are characteristic.

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